Perkutane Totalembolisation der Niere - eine Übersicht

Zusammenfassung

Die perkutane transarterielle Totalembolisation der Niere stellt ein minimalinvasives Therapieverfahren zur radiologischen Nephrektomie dar. In dieser Übersicht werden Indikationen, Technik, Erfolgs- und Komplikationsrate dieses Verfahrens beleuchtet. Mit Ausnahme von in der Regel temporären Beschwerden im Rahmen eines Postembolisationssyndroms, welches mit einer Häufigkeit zwischen 47 % und 100 % angegeben wird, treten Komplikationen relativ selten auf (0 - 20 %) bei einer Mortalitätsrate bis zu 3,3 %. Während die technische Erfolgsrate des Verfahrens unabhängig von der zugrunde liegenden Indikationsstellung hoch ist und in der Regel mit über 90 % angegeben wird, wird die klinische Erfolgsrate maßgeblich von der zu behandelnden Grunderkrankung beeinflusst. Bei inoperablen Tumorleiden kann durch Embolisation eine Verlängerung der Überlebensrate erzielt werden.

Abstract

The percutaneous transarterial total embolization of the kidney is a minimal invasive therapeutic procedure for radiological nephrectomy. The reported indications, technique, results and complications of percutaneous transarterial total renal embolization are reviewed. Aside from transient symptoms as part of the postembolization syndrome with a stated incidence of 47 % to 100 % of embolizations, other complications are relatively rare and occur in the range of 0 % to 20 % with a mortality of up to 3.3 %. Technical success is high and not related to the diagnosis. However, clinical success depends on the underlying disease. Embolization of non-resectable renal tumors may improve the survival rate.

Arteries - therapeutic embolization - kidney - interventional procedures

Literatur

• 1 Lalli A F, Peterson N, Bookstein J J. Roentgen-guided infarctions of kidneys and lungs: a potential therapeutic technique.  Radiology. 1969;  93 434-435
• 2 Almgard L E, Fernstorm I, Haverling M. et al . Treatment of renal adenocarcinoma by embolic occlusion of the renal circulation.  Brit J Urol. 1973;  45 474-479
• 3 Drooz A T, Curtis A L, Timothy E A. et al . Quality Improvement guidelines for percutaneous transcatheter embolization.  J Vasc Interv Radiol. 2003;  14 237-242
• 4 Giuliani L, Carmignani G, Belgrano E. et al . Usefulness of preoperative transcatheter embolization in kidney tumors.  Urology. 1981;  17 431-434
• 5 Lammer J, Justich E, Schreyer H. et al . Complications of renal tumor embolization.  Cardiovasc Intervent Radiol. 1985;  8 31-35
• 6 Onishi T, Oishi Y, Suzuki Y. et al . Prognostic evaluation of transcatheter arterial embolization for unresectable renal cell carcinoma with distant metastasis.  BJU Int. 2001;  87 312-315
• 7 Vogel J, Görich J, v A hlen H. et al . Ergebnisse nach Katheterembolisation bei Nierenzellkarzinom.  Akt Radiol. 1995;  5 301-304
• 8 Zielinski H, Szmigielski S, Petrovich Z. Comparison of preoperative embolization followed by radical nephrectomy with radical nephrectomy alone for renal cell carcinoma.  Am J Clin Oncol. 2000;  23 6-12
• 9 Zupancic B, Bradic I, Batinica S. et al . Our 10-year experience with embolized Wilms’ tumor.  Eur J Pediatr Surg. 1995;  5 88-91
• 10 Munro N P, Woodhams S, Nawrocki J D. et al . The role of transarterial embolization in the treatment of renal cell carcinoma.  BJU Int. 2003;  92 240-244
• 11 Keller F S, Coyle M, Rosch J. et al . Percutaneous renal ablation in patients with end-stage renal disease: alternative to surgical nephrectomy.  Radiology. 1986;  159 447-451
• 12 Iaccarino V, Russo D, Niola R. et al . Total or partial percutaneous renal ablation in the treatment of renovascular hypertension: radiological and clinical aspects.  Br J Radiol. 1989;  62 593-598
• 13 Golwyn D H Jr, Routh W D, Chen M Y. et al . Percutaneous transcatheter renal ablation with absolute ethanol for uncontrolled hypertension or nephrotic syndrome: results in 11 patients with end-stage renal disease.  J Vasc Interv Radiol. 1997;  8 527-533
• 14 Cofan F, Real M I, Vilardell J. et al . Percutaneous renal artery embolisation of non-functioning renal allografts with clinical intolerance.  Transpl Int. 2002;  15 149-155
• 15 Delgado P, Diaz F, Gonzalez A. et al . Transvascular ethanol embolization: first option for the management of symptomatic nonfunctioning renal allografts left in situ.  Transplant Proc. 2003;  35 1684-1685
• 16 González-Satué C, Riera L, Franco E. et al . Percutaneous embolization of the failed renal allograft in patients with graft intolerance syndrome.  BJU Int. 2000;  86 610-612
• 17 Ubara Y, Tagami T, Sawa N. et al . Renal contraction therapy for enlarged polycystic kidneys by transcatheter arterial embolization in hemodialysis patients.  Am J Kidney Dis. 2002;  39 571-579
• 18 Vorwerk D, Günther R W, Kaufmann G. Embolisation der Niere. Günther RW, Thelen M Interventionelle Radiologie Stuttgart; Thieme 1996: 250-257
• 19 Göbel E A, Gött U, Habighorst L V. et al . Anaesthesiologische Gesichtspunkte bei der Katheter-Embolisation zur permanenten Occlusion der Nierenarterie.  Anaesthesist. 1978;  27 131-133
• 20 Kalman D, Varenhorst E. The role of arterial embolization in renal cell carcinoma.  Scand J Urol Nephrol. 1999;  33 162-170
• 21 Weckermann D, Schlotmann R, Tietze W. et al . Gas formation after renal artery embolisation: genesis and clinical relevance.  Urol Int. 1992;  49 211-214
• 22 Kadir S, Marshall F F, White R I Jr. et al . Therapeutic embolization of the kidney with detachable silicone balloons.  J Urol. 1983;  129 11-13
• 23 Gianturco C, Anderson J H, Wallace S. Mechanical device for arterial occlusion.  Amer J Roentgenol. 1975;  124 428-435
• 24 Haapanen A A, Dean P B. Renal vein ethanol concentration during ablation of renal cell carcinoma.  Cardiovasc Intervent Radiol. 1986;  9 205-208
• 25 Riedl P, Flamm J. Kontrollangiographische Befunde nach palliativer Nierenarterienokklusion mit der GAW-(Gianturco, Anderson-Wallace-)Spirale.  Fortschr Röntgenstr. 1979;  130 398-403
• 26 Salamat M, Brown P R, Magee C A. et al . Experimental evaluation of a new transcatheter vascular embolization device in the swine model.  J Vasc Intervent Radiol. 2002;  13 301-312
• 27 Tadavarthy M J, Moller J H, Amplatz K. Polyvinyl alcohol (Ivalon) - a new embolic material.  Amer J Roentgenol. 1975;  125 609-616
• 28 Link D P, Strandberg J D, Virmani R. et al . Histopathologic appearance of arterial occlusions with hydrogel and polyvinyl alcohol embolic material in domestic swine.  J Vasc Interv Radiol. 1996;  7 897-905
• 29 Kauffmann G W, Richter G M. Embolisationsmaterialien. Günther RW, Thelen M Interventionelle Radiologie Stuttgart; Thieme 1996: 220-230
• 30 Fisher R G, Ben-Menachem Y, Whigham C. Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization.  Amer J Roentgenol. 1989;  152 1231-1235
• 31 Leinonen A. Embolization of renal carcinoma. Comparison between the early results of Gelfoam and absolute ethanol embolization.  Ann Clin Res. 1985;  17 299-305
• 32 Ellman B A, Parkhill B J, Marcus P B. et al . Renal ablation with absolute ethanol. Mechanism of action.  Invest Radiol. 1984;  19 416-423
• 33 Cox G G, Lee K R, Price H I. et al . Colonic infarction following ethanol embolization of renal-cell carcinoma.  Radiology. 1982;  145 343-345
• 34 Turner R D, Rand R W, Bentson J R. et al . Ferromagnetic silicone necrosis of hypernephromas by selective vascular occlusion to the tumor: a new technique.  J Urol. 1975;  113 455-459
• 35 Han Y M, Bjarnason H, Gu X. et al . Renal artery embolization with diluted hot contrast medium: an experimental study.  J Vasc Interv Radiol. 2001;  12 862-868
• 36 Park S I, Lee D Y, Won J Y. et al . Renal artery embolization using a new liquid embolic material obtained by partial hydrolysis of polyvinyl acetate (Embol): initial experience in six patients.  Korean J Radiol. 2000;  1 121-126
• 37 Konya A, Wright K C. Capillary embolization using ethiodol-ethanol for complete renal ablation.  Invest Radiol. 2002;  37 512-520
• 38 Helpap B, Brühl P, Thelen M. Morphologische Veränderungen nach arterieller Katheterembolisation der Niere.  Fortschr Röntgenstr. 1978;  128 278-282
• 39 Hall W H, McGahan J P, Link D P. et al . Combined embolization and percutaneous radiofrequenzy ablation of a solid renal tumor.  Amer J Roentgenol. 2000;  174 1592-1594
• 40 Tacke J, Mahnken A, Bücker A. et al . Nephron-sparing percutaneous ablation of a 5 cm renal cell carcinoma by superselective embolization and percutaneous RF-ablation.  Fortschr Röntgenstr. 2001;  173 980-983
• 41 Atar E, Belenky A, Neuman-Levin M. et al . Nonfunctioning renal allograft embolization as an alternative to graft nephrectomy: report on seven years’ experience.  Cardiovasc Intervent Radiol. 2003;  26 37-39
• 42 Hom D, Eiley D, Lumerman J H. et al . Complete renal embolization as an alternative to nephrectomy.  J Urol. 1999;  161 24-27
• 43 Hirao Y, Okajima E, Yoshida K. et al . Renal ablation with absolute ethanol for nonfunctioning hydronephrosis.  Eur Urol. 1993;  24 203-207
• 44 Milewski J B, Malewski A W, Malanowska S. et al . Spinal cord damage as a complication of renal artery embolization in patients with renal carcinoma.  Int Urol Nephrol. 1981;  13 221-229
• 45 Vassiliu P, Sava J, Toutouzas K G. et al . Is contrast as bad as we think? Renal function after angiographic embolization of injured patients.  J Am Coll Surg. 2002;  194 142-146
• 46 Kessel D O, Robertson I, Patel J V. et al . Carbon-dioxide-guided vascular interventions: technique and pitfalls.  Cardiovasc Intervent Radiol. 2002;  25 476-483
• 47 Spinosa D J, Matsumoto A H, Angle J F. et al . Renal insufficiency: usefulness of gadodiamide-enhanced renal angiography to supplement CO2-enhanced renal angiography for diagnosis and percutaneous treatment.  Radiology. 1999;  210 663-672
• 48 Spinosa D J, Kaufmann J A, Hartwell G D. Gadolinium chelates in angiography and interventional radiology: a useful alternative to iodinated contrast media for angiography.  Radiology. 2002;  223 319-325
• 49 Dinkel H P, Danuser H, Triller J. Blunt renal trauma: minimally invasive management with microcatheter embolization - experience in nine patients.  Radiology. 2002;  223 723-730
• 50 Goffette P P, Laterre P F, Miller D C. et al . Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention).  Eur Radiol. 2002;  12 994-1021